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“Chain of Survival”
• Early access • Early CPR • Early defibrillation • Early advanced life support
Defibrillation is “Part of BLS”
• Basic Life Support includes CPR and defibrillation • Early defibrillation with an automated external
defibrillator (AED) has established benefit
• The principle of early defibrillation suggests that the first
person to arrive at the scene of a cardiac arrest should have a defibrillator
• This principle is now internationally accepted
Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care p. I-68
Electrical Conduction System of the Heart
Left Atrium Internodal Pathways Left Bundle Branch Sinoatrial Node Atrioventricular Node Bundle of His
Right Atrium Left Ventricle
Right Bundle Branch
Normal Conduction Pathway in the Heart and the ECG
Sinoatrial (SA) Node Atrioventricular (AV) Node
Left Bundle Branches Right Bundle Branch Purkinje Fibers
T P= Atrial Depolarization QRS = Ventricular Depolarization T= Ventricular Repolarization
Normal Sinus Rhythm
PADDLES X1.0 HR = 74
29MAR96 PADDLES X1.0 HR = 214
PADDLES X1.0 HR = ---
Defibrillation: The Only Effective Treatment for Ventricular Fibrillation
DEFIB 20:29 01APR96 PADDLES X1.0 HR = ---
“Thanks, I needed that!”
Why Early Defibrillation?
• VF most frequent initial rhythm in sudden cardiac arrest • Defibrillation most effective treatment • Probability of defibrillation success diminishes with time • VF tends to rapidly deteriorate into asystole
Textbook of Advanced Cardiac Life Support, Chapter 20, 1990; p. 287
29MAR96 PADDLES X1.0 HR = ---
Resuscitation Success vs. Time*
100 90 80 70 60
Success rates decrease 7-10% each minute
50 40 30 20 10
Adapted from text: Cummins RO, Annals Emerg Med. 1989, 18:1269-1275.
Early Defibrillation Effectiveness
• Rural and urban U.S. studies • Substantial increases in survival
25 20 15 10 5 0 King County Washington Iowa Southeast Minnesota Northeast Minnesota Wisconsin
Textbook of Advanced Cardiac Life Support, Chapter 20, 1990, p. 289
Early Defibrillation by Police and Paramedics—Rochester, MN
Survival to Number hospital discharge First shocked by police First shocked by paramedics 31 53 18 (58%) 23 (43%)
Overall survival to hospital discharge = 49%
White RD, et al. Annals of Emerg Med. 1996;28:480–485.
Time to Defibrillation— The Clock is Ticking
Recognize cardiac arrest 1 min.
Activate internal emergency response 1 min. Call EMS / dispatch vehicle Aid car sent—arrives on scene Locate victim and deliver shock Total Elapsed Time = 1 min. 6 min. 2 min. 11 min.
AEDs are Well Suited for Use by Non-Traditional Responders
• Today’s AEDs are more practical for use
in the workplace and public places
– Voice prompts are more intuitive – Non-rechargeable batteries are the norm – AEDs do daily self tests and are virtually maintenance free
Early Defibrillation by Security Officers: Casino Study
• Landmark study: AED use by nontraditional
responders in out-of-hospital cardiac arrest were trained to use AEDs patient collapse
• Security Officers in various gaming casinos • Goal: to deliver first shock within 3 minutes of
Valenzuela TD, et al: NEJM 2000; 343: 1206-09. Valenzuela TD, et al: NEJM 2000; 343: 1206-09.
Mean time from collapse to first shock Mean time from collapse to medic arrival All VF patients surviving to hospital d/c Witnessed VF patients surviving to hospital d/c 4.4 min. 9.8 min. 53% 59%
Valenzuela TD, et al: NEJM 2000; 343: 1206-09.
Survival Rates for Witnessed VF
100 90 80 70
60 50 40 30 20 10 0 Shock <3 min. after collapse (26/35)
Shock >3 min. after collapse (27/55) National Average
Valenzuela TD, et NEJM 2000; 343: 1206-09. Valenzuela TD, et al: al: NEJM 2000; 343: 1206-09.
Automated External Defibrillators
• Analyze patient ECG
– only for unconscious, pulseless victims with no spontaneous breathing and no signs of circulation
• Determine via computer algorithm shockable or
• Advise operator “SHOCK” or “NO SHOCK” • Shock ventricular fibrillation and certain
LIFEPAK® 500 Automated External Defibrillators
How to Defibrillate
• Verify the victim is unconscious, not breathing,
without a pulse or signs of circulation
• Turn on AED and attach electrodes • ANALYZE heart rhythm • Follow the voice prompts and screen messages
Defibrillation Electrode Placement
Next time, remove his shirt!
Defibrillation Electrode Placement
Correct electrode position
Incorrect electrode position
• Correct electrode position optimizes the amount of
current flowing through the ventricles
• Attach the defibrillator only to someone not • Make sure no one is touching the victim • Be sure the electrodes are firmly adhered to
the victim’s chest defibrillation
breathing and without a pulse or signs of circulation
• Move oxygen away from the rescue effort before
You should have said “clear”!
Who is Using AEDs Today?
• Flight Attendants • Firefighters • EMTs • Corporate Emergency
• Police • Golf Pros • Lifeguards • Health Club Employees
• Security Officers
Advantages of AEDs
• Eliminates need to recognize rhythms • Personnel with less training can defibrillate • May reduce time to therapy—access to more
• Makes early defibrillation practical and achievable